Acitrin Syrp

Acitrin Syrup — Cetirizine 5mg/5ml Antihistamine Syrup (60ml)

1. Indications

Acitrin® Syrup (Cetirizine 5mg/5ml) is the liquid oral formulation of cetirizine — a second-generation non-sedating antihistamine for children and adults who cannot take tablets. Indicated for: seasonal allergic rhinitis (sneezing, runny nose, nasal pruritus, ocular pruritus, tearing, red eyes due to pollen/seasonal allergens); perennial allergic rhinitis (year-round symptoms from dust mites, pet dander, mould); chronic idiopathic urticaria (hives, pruritus, recurrent whealing); allergic conjunctivitis; atopic dermatitis/eczema (pruritus relief); and allergen-induced asthma (as adjunct for allergic component).

The 60ml syrup bottle provides approximately 12 adult doses (10ml/dose) or 6–12 days of treatment.

2. Mechanism of Action

Cetirizine selectively and competitively antagonises histamine at peripheral H1 receptors on smooth muscle, blood vessels, secretory cells, and sensory nerves. By blocking H1 receptor activation, cetirizine prevents histamine-mediated vasodilation, increased vascular permeability, mucus secretion, and pruritic nerve stimulation. As a piperazine derivative and active metabolite of hydroxyzine, cetirizine also has mild mast cell-stabilising activity. The syrup formulation provides equivalent bioavailability to the tablet.

3. Dosage & Administration

Adults and children ≥6 years: 2 teaspoonfuls (10ml = 10mg) once daily; or 1 teaspoonful (5ml = 5mg) twice daily. Children 2–6 years: 1 teaspoonful (5ml = 5mg) once daily; or ½ teaspoonful twice daily. Infants 6 months to <2 years: ½ teaspoonful (2.5ml = 2.5mg) once daily; may increase to ½ teaspoonful twice daily.
Renal/hepatic impairment: 1 teaspoonful (5mg) once daily in adults with CrCl 11–31 ml/min or on dialysis. Measure dose accurately with calibrated measuring spoon — 1 teaspoon = 5ml. Shake well before use. May be taken with or without food.

4. Side Effects

Well tolerated. Mild drowsiness (lower incidence than chlorpheniramine). Headache, dry mouth, nausea. GI: mild abdominal discomfort. In young children: paradoxical excitability possible. No anticholinergic effects (no urinary retention, dry eyes, constipation at standard doses). No blood glucose effect in diabetic patients.

5. Contraindications

Hypersensitivity to cetirizine, hydroxyzine, or excipients. Severe renal impairment (CrCl <10 ml/min). Caution in pregnancy (first trimester). Not recommended in breastfeeding.

6. Warnings & Precautions

Use calibrated measuring spoon for dosing — teaspoon volume varies between household spoons. Avoid alcohol and CNS depressants. Caution driving in sensitive individuals. Dose reduction in renal impairment. For children under 2 years: use only under physician supervision. Diabetic patients: syrup may contain sugar — check formulation; sugar-free formulations preferred for diabetics.

7. Drug Interactions

No clinically significant interactions at standard doses with: theophylline (low dose), azithromycin, erythromycin, ketoconazole, pseudoephedrine, or common diabetes medications. Additive CNS depression with sedatives and alcohol. Low CYP450 interaction risk.

8. Pharmacokinetics

Oral bioavailability ~70%. Tmax ~1h. Protein binding 93%. Half-life ~10h (6h in young children). Primarily renal elimination. Equivalent systemic exposure to tablet formulation. Onset of antihistamine effect within 1 hour. Duration: 24 hours (once-daily dosing in adults).

9. Storage

Store below 30°C (cool, dry place), protected from light. Keep tightly closed after each use. Shake well before measuring. Discard after expiry date. Keep out of reach of children.

10. Course Duration

For seasonal allergic rhinitis: take throughout the symptomatic pollen season. For chronic urticaria: regular daily dosing as prescribed by physician. For acute urticaria or insect reactions: short course 3–7 days typically.

11. Overdose

Overdose most likely effect: hypotension. In children: paradoxical excitation or drowsiness. Symptomatic and supportive management. No specific antidote. Not dialyzable.

12. Clinical Evidence

Cetirizine is the most prescribed liquid antihistamine for children in Bangladesh. Extensively studied in paediatric allergic rhinitis, urticaria, and atopic dermatitis. The ETAC study (Early Treatment of the Atopic Child) showed cetirizine 0.25mg/kg twice daily reduced asthma onset in high-risk infants. ACI's Acitrin Syrup formulation follows BP standard — equivalent bioavailability to tablet documented in pharmacokinetic studies.

13. Patient Counselling

Always use a proper measuring spoon or oral syringe — not a household teaspoon. Shake well before measuring. Take at the same time each day; evening preferred to minimise drowsiness. Avoid alcohol. Report severe drowsiness or paradoxical agitation in children. Diabetic patients: consult physician regarding sugar content of the syrup formulation.

Frequently Asked Questions (FAQ)

Q1. How much Acitrin Syrup should I give my 3-year-old child?
For a child aged 2–6 years: 1 teaspoonful (5ml = 5mg cetirizine) once daily is the standard dose — equivalent to 5mg. This may be given as ½ teaspoonful twice daily if preferred. Do not exceed 5mg/day for this age group. Use a calibrated measuring spoon or the syringe provided — not a household teaspoon, which may not measure exactly 5ml. For infants under 2 years (6 months+): ½ teaspoonful (2.5ml) once daily, as directed by physician.

Q2. Can diabetic patients take Acitrin Syrup?
Cetirizine itself does not affect blood glucose. However, some oral syrups contain sucrose (sugar) as an excipient — diabetic patients and caregivers should check the label or consult ACI for the exact sugar content per dose. If sugar content is a concern, Acitrin® Tablet 10mg provides the same active ingredient without liquid sweeteners. All common diabetes medications (metformin, insulin, SGLT-2 inhibitors) are free of interactions with cetirizine. Dose adjustment needed only if significant renal impairment is present.

Q3. How long does a 60ml bottle of Acitrin Syrup last?
A 60ml bottle lasts: Adults (10ml/day dose) — 6 days. Children 2–6 years (5ml/day) — 12 days. Infants 6–24 months (2.5ml/day) — 24 days. For seasonal rhinitis where a full season of treatment is needed, multiple bottles will be required. Store opened bottles tightly closed in a cool place and use before the expiry date. The bottle should not be used beyond 6 months after first opening (check label for specific shelf life after opening).

Q4. Is Acitrin Syrup the same as Acitrin-L Oral Solution?
No — they contain different antihistamines. Acitrin® Syrup contains cetirizine dihydrochloride 5mg/5ml. Acitrin-L® Oral Solution contains levocetirizine dihydrochloride 2.5mg/5ml. Levocetirizine is the active R-enantiomer of cetirizine — approximately twice as potent, so 2.5mg levocetirizine is equivalent to 5mg cetirizine. Both are ACI products, once-daily antihistamines. Acitrin-L has slightly stronger potency per dose and may have a marginally improved side-effect profile in some patients.

⚕ Medical Disclaimer: Acitrin® Syrup is a prescription antihistamine. Always use a calibrated measuring spoon for dosing in children. Information sourced from ACI Pharmaceuticals Ltd. official prescribing data. Educational purposes only.